The Association of Left Ventricular Hypertrophy with Metabolic Syndrome is Dependent on Body Mass Index in Hypertensive Overweight or Obese Patients

Overweight (Ow) and obesity (Ob) influence blood pressure (BP) and left ventricular hypertrophy (LVH). It is unclear whether the presence of metabolic syndrome (MetS) independently affects echocardiographic parameters in hypertension.380 Ow/Ob essential hypertensive patients (age ≤ 65 years) presenting for referred BP control-related problems. MetS was defined according to NCEP III/ATP with AHA modifications and LVH as LVM/h(2.7) ≥ 49.2 g/m(2.7) in males and ≥ 46.7 g/m(2.7) in females. Treatment intensity score (TIS) was used to control for BP treatment as previously reported.Hypertensive patients with MetS had significantly higher BMI, systolic and mean BP, interventricular septum and relative wall thickness and lower ejection fraction than those without MetS. LVM/h(2.7) was significantly higher in MetS patients (59.14 ± 14.97 vs. 55.33 ± 14.69 g/m(2.7); p = 0.022). Hypertensive patients with MetS had a 2.3-fold higher risk to have LVH/h(2.7) after adjustment for age, SBP and TIS (OR 2.34; 95%CI 1.40-3.92; p = 0.001), but MetS lost its independent relationship with LVH when BMI was included in the model.In Ow/Ob hypertensive patients MetS maintains its role of risk factor for LVH independently of age, SBP, and TIS, resulting in a useful predictor of target organ damage in clinical practice. However, MetS loses its independent relationship when BMI is taken into account, suggesting that the effects on MetS on LV parameters are mainly driven by the degree of adiposity

Subclinical Right Ventricular Dysfunction in Cystic Fibrosis

Patients with severe cystic fibrosis can develop cor pulmonale, but little is known about the function of the right ventricle (RV) early in the disease. We hypothesized that such patients might have subclinical RV dysfunction, detectable by tissue Doppler echocardiography, and related to the severity of lung disease. We studied 21 clinically stable patients (Group 1), five patients with severe lung disease (Group 2), and 23 age-matched healthy subjects. Patients had impaired RV systolic function. The mean (SD) systolic velocities of the RV free wall were 8.9 (1.7) cm/s in Group 1, 7.7 (1.0) in Group 2, and 10.8 (1.9) in healthy subjects (p < 0.001). The velocities of the tricuspid annulus were less in patients (p < 0.0001). Patients had a greater isovolumic relaxation time (p < 0.001), indicating RV diastolic dysfunction. RV wall thickness was greater in patients (0.4 [0.1] versus 0.3 [0.1] cm/m(2), p < 0.01). RV systolic function was related to C-reactive protein (r = - 0.66, p < 0.001) and FEV(1) (r = 0.62, p = 0.003) and diastolic function to interleukin-6 (r = 0.64, p < 0.005). Patients with cystic fibrosis have subclinical RV dysfunction, which correlates with the severity of lung disease. Tissue Doppler echocardiography provides a quantifiable indicator useful for detection and monitoring of disease progression

Doença de Chagas em Virgem da Lapa, Minas Gerais, Brasil. IV. Aspectos clínicos e epidemiológicos do aneurisma ventricular esquerdo Chagas' disease in Virgem da Lapa County, Minas Gerais State, Brazil. IV. Clinical and epidemiological aspects of the left ventricle aneurism

Com o objetivo de avaliar as características clínicas e epidemiológicas do aneurisma ventricular esquerdo na doença de Chagas crônica, 388 indivíduos não selecionados: 298 chagásicos e 90 não-chagásicos, foram submetidos ao exame ecocardiográfico. A função ventricular foi avaliada ao modo M através do cálculo da fração de ejeção e ao bidimensional através da análise subjetiva da função sistólica global e a contratilidade regional foi avaliada pelo modelo da Sociedade Americana de Ecocardiografia. Foram diagnosticados 56 (18,8%) aneurismas do ventrículo esquerdo, todos entre os chagásicos, sendo 38 (12,7%) no segmento apical, 10 (3,4%) no septo interventricular, 2 (0,7%) ápico-septal, 2 (0,7%) na parede posterior, 2 (0,7%) na parede inferior e 2 (0,7%) no segmento ínfero-posterior. Não houve diferença significativa nas freqüências dos aneurismas em relação à faixa etária, ao sexo e à etnia. Não houve associação entre aneurismas e hipertensão arterial. Dos 56 indivíduos com aneurismas, 55 (98,2%) eram sintomáticos com predominância de palpitações, 53 (94,6,%) apresentaram ECG anormais, com predominância de extra-sístoles ventriculares, seguidas de alterações da condução e 34 (60,7%) apresentaram comprometimento da função ventricular, sem diferença quanto ao segmento acometido. Diante destes resultados podemos considerar o aneurisma ventricular esquerdo, principalmente apical, como um marcador de doença de Chagas e um indicador da alta morbidade da infecção humana pelo T. cruzi em Virgem da Lapa.<br>The study aimed at the evaluation of the clinical and epidemiological characteristics of the aneurism found in the left ventricle in chronic Chagas' disease patients. Three handred, eighty eight people (298 chagasic patients and 90 randomly selected healthy individuals) were submitted to echocardiography. The ventricular function was assessed in the M mode by calculating the fraction of ejection, and in the bidimensional mode by analyzing he global systolic function. Segmental contractility was evaluated according to the method described by American Society of Echocardiography. Aneurism of the left ventricle was diagnosed in 58 (18.8%) patients, all from the chagasic population. From these, 38 (12.7%) were found in the apical segment; 10 (3.4%) in the interventricular septum; and 2 (0.7%) each in the posterior wall; the inferior wall; apico-septal; and inferior-posterior. We could not observe any significant difference for the aneurism frequencies in relation to age group, gender and race, and no association between aneurism and arterial hypertension could be made. Of the 56 individuals presenting aneurism, 55 (98.2%) were symptomatic with predominant palpitations; 53 (94.6%) showed an aberrant ECG with predominant ventricular extra-systoles followed by changes in conduction; and 34 (60.%) showed an impairment of the ventricular function, regardless of the affected segment. In view of these results we consider the apical aneurism of the left ventricle as a marker of Chagas' disease and as an indicator of high morbidity of the human T. cruzi infection in Virgem da Lapa

Asymptomatic Cardiomyopathy in Children and Adolescents with Type 1 Diabetes Mellitus: Association of Echocardiography Indicators with Duration of Diabetes Mellitus and Metabolic Parameters

This study was designed to determine the relationship of dimensions, wall thickness and function of the left ventricle with diabetes duration, fasting blood glucose, lipid profile, beta-OH-butyrate, free fatty acids (FFA) and carnitine levels in children and adolescents with type 1 diabetes mellitus (DM1) who had no cardiovascular complications. Thirty-five patients with DM1. (18 F/17 M, mean age: 12.0 years) and age matched control children (n = 24) were enrolled in the study. Patients with DM1 were subdivided into Group I (mean DM1 duration 3.5 years, n = 14), and Group II (mean DM1 duration 8.2 years, n = 21). Dimensions, wall thickness and systolic functions of the left ventricle were normal in all patients with DM1. Diastolic functions were normal in Group I. In Group II, peak A wave velocity (AVEL) (p = 0.004), velocity-time integral of A wave (AVTI) (p = 0.007) and isovolumetric relaxation time corrected by heart rate (cIVRT) (p = 0.048) were high, and peak E wave velocity (EVEL) and velocity-time integral of E wave (EVTI) were normal. E/A (p < 0.0001) and EVTI/AVTI (p = 0.001) were low in this group. In Group 1, systolic and diastolic blood pressure, HDL-cholesterol and FFA values were normal; total cholesterol (p = 0.047), LDL-cholesterol (p = 0.017), beta-OH-butyrate (p = 0.003), and acetyl carnitine (p = 0.006) levels were high. In Group 11, diastolic blood pressure (p = 0.008), total cholesterol (p < 0.0001) and LDL-cholesterol (p < 0.0001) were increased; and total carnitine (p = 0.019), free carnitine (p = 0.002) and HDL-cholesterol (p = 0.039) were decreased. Correlations were detected between total carnitine and AVEL and HR; free carnitine and AVEL, E/A and HR; HbA(1c) and EVTI/AVTI and cIVRT; LDL-cholesterol and E/A, EVTI/AVTI ratios and cIVRT; HDL-cholesterol and AVEL; FFA and LVDD, IVSD, LVPWD, LVmass and CO; metabolic parameters and DM1 duration and echocardiographic findings such as AVEL, EVEL, EVTI, VmaxAV and CO. In conclusion, left ventricular dimensions, wall thickness and systolic functions were normal in children and adolescents with DM1 who had no obvious cardiovascular complications. Left ventricular diastolic functions were abnormal in patients of Group II. Left ventricular diastolic function abnormalities were associated with glycemic control, free and total carnitine, and LDL- and HDL-cholesterol levels

Teste ergométrico e o Holter de 24 horas na detecção de arritmias ventriculares complexas em diferentes estádios da cardiopatia chagásica crônica Exercise testing and 24 hours Holter monitoring in the detection of complex ventricular arrhythmias in different stages of chronic Chagas' heart disease

Comparou-se o teste ergométrico com Holter de 24 horas na detecção de arritmias ventriculares complexas em diferentes estádios da cardiopatia chagásica crônica. Avaliados 71 pacientes sem outras doenças associadas, idade=51±10,3, metade mulheres. Divididos em quatro grupos conforme o grau de acometimento cardíaco. A estatística esta discriminada no corpo do trabalho. Ao Holter, no grupo IA as arritmias ventriculares complexas foram detectadas em 4,3%, IB em 25%, II em 55% e no grupo III em 90%. Nos grupos II e III não houve diferença entre os exames na detecção de arritmias ventriculares complexas (p=NS). Nos grupos IA e IB, houve uma concordância de 100% no teste ergométrico na não detecção de arritmias ventriculares complexas entre dois observadores. No grupo II, a concordância foi de 70% (kappa=0,368, p=0,003) e de 90% (kappa=0,78, p=0,002) no grupo III. Foi observado diferenças na presença de arritmias ventriculares complexas entre os pacientes dos grupos em fase inicial e avançada da cardiopatia chagásica crônica. Nos pacientes dos grupos II e III não houve diferença entre os dois exames na detecção das arritmias ventriculares complexas. Pacientes dos grupos IA e IB é razoável indicar Holter e/ou o teste ergométrico na ocorrência de progressão da doença.<br>To detect complex ventricular arrhythmias in different stages of chronic chagasic cardiopathy, the results of exercise testing to 24 hours Holter monitoring have been compared. We evaluated a group of 71 patients, half women, aged 51±10.3, with no others associated diseases. These patients were separated in 4 groups according to degree of cardiac involvement. Statistical data can be found elsewhere in the study. In group IA, Holter monitoring detected 4.3% of complex ventricular arrhythmias, group IB 25%, group II 55% and group III 90%. We found no difference between Holter and exercise testing in the detection of complex ventricular arrhythmias in groups II and III (p = ns). In groups IA and IB we found 100% concordance, concerning the no detection of complex ventricular arrhythmias by exercise testing seen by two independent examiners. In group II there was a 70% concordance (kappa=0.368, p=0.003) and 90% in group III (kappa=0.78, p=0.002). Different results were found, concerning the presence of complex ventricular arrhythmias, among patients in the initial and advanced stages of chronic chagasic cardiopathy. In groups II and III we found no difference between the two methods in the detection of complex ventricular arrhythmias. It seems reasonable to recommend either Holter on exercise testing in groups IA and IB if progression of disease is noticed